Provider Demographics
NPI:1346938537
Name:MACKENTHUN, ANNA MAE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MAE
Last Name:MACKENTHUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9935 BABCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PLATO
Mailing Address - State:MN
Mailing Address - Zip Code:55370-5628
Mailing Address - Country:US
Mailing Address - Phone:320-300-8300
Mailing Address - Fax:
Practice Address - Street 1:3900 BETHEL DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-6902
Practice Address - Country:US
Practice Address - Phone:320-300-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant